A Diagnosis of Denial: How Mental Health Classification Systems Have Struggled to Recognise Family Violence as a Serious Risk Factor in the Development of Mental Health Issues for Infants, Children, Adolescents and Adults

Abstract

Child and adolescent mental health services (CAMHS) routinely overlook assessing for, and providing treatment to, infants and children living with family violence, despite family violence being declared endemic across the globe. As contemporary neuro-developmental research recognises the harm of being exposed to early relational trauma, key international diagnostic texts such as the DSM-5 and ICD-10 struggle to acknowledge or appreciate the relational complexities inherent in addressing family violence and its impacts during childhood. These key texts directly influence thinking, funding and research imperatives in adult services as well as CAMHS, however, they rarely reference family violence. Their emphasis is to pathologise conditions over exploring causality which may be attributable to relational violence. Consequently, CAMHS can miss important indicators of family violence, misdiagnose disorders and unwittingly, not address unacceptable risks in the child’s caregiving environment. Notwithstanding urgent safety concerns, ongoing exposure to family violence significantly heightens the development of mental illness amongst children. CAMHS providers cannot and should not rely on current diagnostic manuals alone. They need to act now to see family violence as a significant and important risk factor to mental health and to treat its impacts on children before these develop into enduring neurological difficulties.

Impact of the Familiar Environment in 11–14-Year-Old Minors’ Mental Health

“…Some studies have analyzed family relationships from the point of view of family violence, either between parents [ 26 , 27 ] or from parents to children [ 28 ]. In this sense, the “Interpersonal Acceptance-Rejection theory” (IPARTheory) [ 29 ] analyzes the influence of parents’ affections on their children and how these perceptions or experiences can affect the cognitive and socio-emotional adjustment of children [ 9 ].…”

Empowering young people who experienced domestic violence and abuse: The development of a group therapy intervention

“…Due to funding constraints, the pilot of MPOWER was run without a parallel support group for parents. The availability of more holistic support was a clear limitation of this programme (see Bunston, 2017; Bunston, Franich-Ray, & Tatlow, 2017; Katz, 2016; Stanley, Ellis, & Bell, 2011) and has been factored into our planning for subsequent deliveries of the intervention. We were also acutely aware of delivering this intervention in times of significant socioeconomic uncertainty.…”

“…Although the direct YP voices are absent from this article, their reflections on their participation in these groups are presented in another paper (Callaghan et al, 2018), as are the results from routine outcome measures (ROMs) that were used to track therapeutic change and group cohesion at the beginning and the end of each. The overall positive feedback of YP was balanced against a sense of insufficient time, and a strongly expressed view in all four countries that 10 sessions were not sufficient for the work that YP wished to do as part of the intervention (see also Bunston et al, 2017; Houghton, 2015). The toolkit we developed for the programme (Fellin et al, 2015) is sufficiently flexible to extend the duration of the programme beyond 10 sessions when practically and financially viable.…”

“…Future iterations of the MPOWER programme will run over a longer period, where funding and commissioning practices enable this. As Bunston et al (2017) note, it is important, as far as possible, not to rush this work.…”

International and Spanish Findings in Scientific Literature about Minors’ Mental Health: Predictive Factors Using the Strengths and Difficulties Questionnaire

“…In this sense, it is advisable to advance the research using other versions of the SDQ in Spain, such as the self-report with children from the age of 11. Likewise, there are other variables, such as family relationships, from the point of view of family violence, either between parents [76], or from parents to children [77], that should also be analyzed. In this sense, the theory of parental rejection acceptance [78] could be interesting for analyzing the influence of parental affections on their children, and how these perceptions or experiences can affect the cognitive and socioemotional adjustment of minors [79].…”